Volume 40 · Issue 09 · 2024

Cerebral hemorrhage is one of the important types of stroke, and has been a hot and difficult point in basic research and clinical research for a long time. Although a lot of research has been conducted around cerebral hemorrhage, the results that can be practically applied to the clinic are very limited. It is worth noting that the existing basic scientific research only covers a small part of the cerebral hemorrhage situation, and most animal models adopt a single age, a single sex and the same bleeding amount; However, the cases included in clinical research show great heterogeneity, covering different age levels, basic health status, bleeding volume, and whether surgical treatment is needed, etc., making the transformation from basic research to clinical application often difficult to achieve ideal state. In the future, both basic and clinical studies should be more detailed to better reflect the diversity of patients. In addition, the role of intracranial venous reflux in the occurrence and development of cerebral hemorrhage, especially the local intracranial pressure and venous blood flow velocity after cerebral hemorrhage, should be fully paid attention to. Refining the study classification and the role of venous system in cerebral hemorrhage may be the future research direction of cerebral hemorrhage.

Gliomas are the most common tumors of the central nervous system (CNS) in children, among which high-grade gliomas, although relatively rare, are the most common cause of tumor-related death in children. pediatric high-grade glioma (PHGG) accounts for about 6% to 15% of all intracranial tumors in children^[1]Despite surgery, radiotherapy, and systemic treatment, the 5-year survival rate was only 20%^[1]。 Spinal cord PHGG is rare, accounting for approximately 7.5% of pediatric spinal cord tumors, compared to only 5% of pediatric CNS tumors^[2,3]。 In the 2021 World Health Organization (WHO) CNS Tumor Classification, PHGG no longer distinguishes between Grade 3 and Grade 4 tumor grades, collectively referred to as "Child High Grade"^[1]。 In order to standardize and guide the diagnosis and treatment of PHGG, this guide will elaborate and recommend from the aspects of imaging examination and evaluation, pathological examination and diagnosis, surgery, radiotherapy and systemic treatment principles of PHGG, for the reference of medical workers engaged in the diagnosis and treatment of pediatric neurotumors. This guide puts forward recommendations based on the grading of recommendations assessment, development and evaluation (GRADE) method (Table 1), combined with literature evidence quality GRADE, clinical practice application and expert opinions. The recommendations were reviewed and approved by 23 multidisciplinary experts, among which the contents with insufficient evidence of evidence-based medicine need to be further verified and updated in future clinical trials.

To explore the relationship between sacrococcygeal dimples and filum terminale degeneration in children.

A total of 343 children who visited the Department of Neurosurgery of Shanghai Children′s Medical Center, Shanghai Jiao Tong University School of Medicine from April 2015 to March 2020 with the main complaint of sacrococcygeal dimples who underwent MRI lumbar spine examination were included. Surgical treatment was performed for children with filum terminale degeneration found on MRI (MRI positive) or with obvious tethered cord symptoms despite negative MRI findings. The occurrence of filum terminale degeneration in children with sacrococcygeal dimples was retrospectively analyzed, and the differences in filum terminale degeneration in children with different imaging manifestations were analyzed.

Among the 343 children, 166 (48.4%) were confirmed to have filum terminale degeneration by surgery. Preoperative MRI was positive in 152 cases (44.3%) and negative in 191 cases (55.7%). Among the 152 children with positive MRI, 52 cases showed degeneration of the filum terminale in both sagittal and axial images, and 100 cases showed degeneration of the filum terminale only in axial images. Among the 191 children with negative MRI findings, 14 cases (7.3%) underwent surgical exploration due to obvious symptoms of tethered cord, and degeneration of the filum terminale was found in all cases during the operation. Intraoperatively, the maximum diameter of the filum terminale in the group with positive sagittal and axial MRI images, the group with positive axial images only, and the group with negative MRI images was 3.58±1.17 mm, 2.32±0.56 mm, and 2.04±0.37 mm, respectively, with statistically significant differences (P<0.001). Postoperative pathology showed that among the 52 cases with positive MRI sagittal and axial images, 50 cases (96.2%) had fatty degeneration and 2 cases (3.8%) had fibrofatty degeneration; among the 100 cases with positive axial images only, 95 cases (95.0%) had fatty degeneration, 4 cases (4.0%) had fibrofatty degeneration, and 1 case (1.0%) had fibrotic degeneration; among the 14 cases with negative MRI findings, 7 cases had fatty degeneration, 1 case had fibrofatty degeneration, and 6 cases had fibrotic degeneration; the differences in pathological types among the three groups were statistically significant (P<0.001). None of the 166 children who underwent surgery had surgery-related nerve injury symptoms or cerebrospinal fluid leakage. Follow-up at 6 months post surgery showed that the symptoms of children with preoperative symptoms were significantly improved.

Children with sacrococcygeal dimples have a high probability of filum terminale degeneration. MRI axial scanning can help improve the positive detection rate of MRI. Filum terminale degeneration cannot be ruled out in patients with negative MRI findings. The detection rate of filum terminale degeneration on MRI is related to the diameter of the filum terminale and the pathological type. Filum terminale fiber degeneration is not easily detected by MRI.

To investigate the pathogenesis, surgical treatment and prognosis of abnormal eye movement and hemifacial spasm secondary to pontine tumor close to the fourth ventricle in children.

A retrospective case series study was used to analyze the clinical data of 9 children with abnormal eye movement and hemifacial spasm secondary to periventicular pontine tumor admitted to the Department of Neurosurgery, Beijing Children′s Hospital Affiliated to Capital Medical University from July 2016 to August 2021. Seven children had previously been treated with oral antiepileptic drugs, with 6 showing no effect and 1 experiencing a 50% reduction in seizure frequency. Preoperative diffusion tensor imaging (DTI) in 4 children showed a close relationship between the tumor and the abducens nucleus and facial nucleus. All 9 cases were resected by cerebellar medullary fissure approach. Deep electroencephalogram monitoring was performed in 5 cases and tumor discharges were recorded. The outcome was evaluated by clinical and imaging follow-up at 3, 6, 12 months after surgery.

Total tumor resection was achieved in all 9 cases. Among them, 8 cases showed gangliomas (WHO grade 1) and 1 case was hamartoma. Among the 5 children, 3 had 1 to 3 spike-like discharges recorded from the deep part of the tumor, while no discharges were recorded in the other 2 children. Postoperatively, all 9 children experienced an immediate cessation of seizure symptoms without the use of antiepileptic drugs. The follow-up time of 9 cases was 28-89 months (median: 39 months), and no recurrence of tumor and recurrence of symptoms was found until the last follow-up. One case showed reduced muscle strength in right side and left eye inward strabismus. On the last follow-up, the muscle strength restored but the left eye remain inward strabismus.

Children with paraventricular pontine tumors who present with paroxysmal eye movement abnormalities and hemifacial spasm are ineffective in conventional anti-epileptic treatments. Early total tumor resection can achieve clinical cure; their paroxysmal symptoms may be related to the abnormal discharge of the tumor.

To explore the surgical efficacy of modified hemispherotomy in the treatment of children with Sturge-Weber syndrome (SWS) complicated by epilepsy.

A retrospective analysis was conducted on the clinical data of 38 children with SWS complicated by epilepsy who were treated with modified hemispherotomy at the Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University from January 2009 to December 2020. The children′s surgical efficacy, including seizure outcome and improvement in cognitive function, was followed up through outpatient clinics or online platforms 2 years after surgery and analyzed. Epileptic seizure outcome was assessed based on the International League Against Epilepsy (ILAE) criteria, and cognitive function was assessed using the Kelly score. At the same time, the cognitive function scores of children before and after surgery were stratified according to the age of surgery ≤ 1 year old, > 1 to 3 years old, > 3 to 6 years old, and > 6 years old.

A total of 38 children underwent modified hemispherotomy. There were no instances of mortality or the development of neurological deficits following surgery. At the two-year follow-up, 33 of the 38 children exhibited ILAE grade 1, 2 exhibited grade 3, 1 exhibited grade 4, and 2 exhibited grade 5. With regard to cognitive function, the children′s cognitive function scores were superior to their preoperative scores at the two-year follow-up, with a statistically significant difference observed between the two groups (1.32±0.96 vs. 1.79±1.09). The paired t-test yielded a statistically significant result (t=3.17, P=0.003). Of the 38 children, 16 exhibited improved cognitive function postoperatively compared with their preoperative scores, 19 demonstrated no change, and 3 exhibited a decline. Postoperative cognitive function scores (0.90±0.57) and (1.20±1.01) were superior to preoperative scores (1.80±1.14) and (1.73±1.10) in children aged ≤1 year and >1-3 years following surgery. The observed differences were statistically significant (all P<0.05), whereas the differences between the preoperative and 2-year postoperative cognitive function scores in children aged >3-6 and >6 years were not statistically significant (all P>0.05).

Modified hemispherotomy can safely and effectively control seizures in medically refractory epilepsy complicated by SWS and can improve cognitive function to some extent in children.

To investigate the risk factors for post-traumatic epilepsy(PTE) progressing from early drug-controlled status to drug-resistant epilepsy(DRE) in children.

A retrospective analysis was performed on the clinical data of 232 pediatric patients with post-traumatic epilepsy who were admitted to Department of Neurosurgery, the Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital from January 2013 to June 2023. All patients were ≤14 years old, and the follow-up time was >2 years. Among them, 54 cases were in the DRE group and 178 cases were in the non-DRE group. The differences in clinical data between the two groups were compared to screen for factors that influence the progression of PTE to DRE. The statistically significant differences between the two groups were included in the multivariate logistic regression model for analysis, and the independent risk factors that influenced the progression of PTE to DRE in children were screened.

Compared with the non-DRE group, the DRE group had a higher proportion of children who were ≤7 years old, whose brain injury site was the temporal lobe, brain contusion and laceration, who did not undergo surgery within 24 hours after the injury, whose electroencephalogram showed epileptic discharges, and who had poor medication compliance (all P<0.05). However, there were no statistically significant differences in the gender, cause of injury, open craniocerebral injury, or Glasgow Coma Score on admission between the two groups of children (all P>0.05). Multivariate logistic regression analysis showed that age ≤7 years old (OR=7.27, 95%CI: 2.59-20.40), brain injury site in the temporal lobe (OR=13.06, 95%CI: 3.41-49.97), brain contusion (OR=5.36, 95%CI: 1.18-24.41) were associated with the progression of PTE to DRE (all P<0.05).

Age ≤7 years old, temporal lobe damage, and brain contusion are independent risk factors for children with PTE to progress to DRE.

To investigate the effect of endoscopic third ventriculostomy (ETV) on the treatment of ventriculoperitoneal (VP) shunt malfunction in children.

The clinical data of 29 children with VP shunt dysfunction after hydrocephalus surgery who were admitted to the Neurosurgery Department of the Pediatric Hospital of Fudan University from June 2016 to June 2023 were retrospectively analyzed. All children underwent ETV. Based on the improvement of clinical symptoms after surgery, the criterion for success of ETV was that ventriculo-peritoneal shunt (VPS) was not performed again for 3 months or more after operation, while the criterion for failure of ETV was that VPS was performed again within 3 months after ETV.

Among the 29 child patients, 18 were male and 11 were female; the age of ETV child patients [M(Q₁, Q₃)] was 84.0 (46.5, 120.5) months, and the age of first VPS treatment [M(Q₁, Q₃)] was 5.7 (2.0, 18.0) months. Twenty patients were diagnosed with obstructive hydrocephalus and 9 patients with communicating hydrocephalus. The causes of shunt dysfunction were shunt-related infection in 3 cases, shunt displacement and head-end obstruction in 19 cases, shunt rupture in 3 cases, and slit ventricular syndrome (SVS) in 4 cases. The longest follow-up time of 29 child patients was 90 months. As of the last follow-up, the effective rate of ETV was 55.2% (16/29), among which the effective rate of ETV in patients with communicating hydrocephalus was 6/9, and the effective rate of ETV in child patients with obstructive hydrocephalus was 50.0% (10/20). The ETV effective rate of patients with communicating hydrocephalus tended to be higher than that of child patients with obstructive hydrocephalus, but the difference was not statistically significant (P>0.05). The success rate of surgery in 4 patients with SVS was only 1/4.

ETV has a certain application effect in VP shunt dysfunction. It can be used as an alternative to shunt revision surgery and can be applied in patients with any type of VP shunt dysfunction.

The clinical data of 18 children with cerebellar vermis tumors treated by neuroendoscopic surgery in the same treatment group from January 2021 to January 2024 in the Department of Pediatric Neurosurgery of Guizhou Hospital of Shanghai Children's Medical Center (15 cases) and the Department of Neurosurgery of Guizhou Provincial People's Hospital (3 cases) were retrospectively analyzed. Among them, 16 cases were totally resected, 1 case was subtotally resected, and 1 case was biopsied. Postoperative pathological findings: 9 cases of medulloblastoma, 3 cases of ependymoma and 5 cases of astrocytoma; The postoperative pathological findings of the children who underwent biopsy suggested benign cerebellar lesions. The major perioperative complications included cerebellar mutism in 4 cases, ataxia in 13 cases, and death due to malignant arrhythmia in 1 case. Seventeen children completed clinical follow-up, the follow-up time was 1 to 36 months after operation, and 2 cases developed communicating hydrocephalus, which improved after ventricular-peritoneal shunt operation; The symptoms of children with cerebellar mutism and ataxia were improved compared with those at discharge. At the last follow-up, the tumor recurred in 3 cases. Neuroendoscopic surgery to remove cerebellar vermis tumors can meet the requirements of exposure, and the total resection rate of tumors is high, which provides another option besides microscopic surgery.

To preliminarily investigate the relationship between the expression of VEGFA, VEGFR1/2 and microvascular density in tumor tissues and the recurrent glioblastoma patients′ therapeutic response to super-selective intraarterial bevacizumab.

Between October 2017 and May 2023, 14 recurrent glioblastoma patients who received super-selective intracranial arterial infusion of bevacizumab in the Department of Neurosurgery at Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School were enrolled in this study. The efficacy of the treatment was evaluated using the Response Assessment in Neuro-Oncology (RANO) criteria. Patients who achieved disease control including complete response, partial response, stable disease were defined as the treatment-effective group, while those who did not achieve disease control were classified as the treatment-ineffective group. There were 7 patients both in the treatment-ineffective and effective group. VEGFA and VEGFR1/2 expressions were assessed by immunohistochemistry staining. Microvessel density was assessed by immunohistochemistry analysis with antibody targeting CD34. The differences in VEGFA, VEGFR 1/2 protein expression levels and microvessel density between the two groups were analyzed.

Compared with the treatment-ineffective group, the expression level of VEGFA (5.71±2.21 vs. 1.86±0.90, t=4.27, P=0.003) and microvessel density (46.7±16.7 vs. 23.4±5.7 per 400×magnification, t=3.50, P=0.009) in tumor tissues significantly increased in the treatment-effective group, while there was no significant difference in the VEGFR 1/2 expression (both P>0.05).

The preliminary study has shown that expression level of VEGFA and microvessel density in tumor tissue are correlated with the clinical efficacy in recurrent glioblastoma patients treatment with super-selective intracranial arterial infusion of bevacizumab.

To investigate the early warning factors and short-term efficacy of complications after intracranial-extracranial revascularization in patients with symptomatic atherosclerotic internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion.

The clinical data of patients with symptomatic atherosclerotic ICA or MCA occlusion who underwent intracranial-extracranial revascularization at the Neurosurgery Center of Beijing Tiantan Hospital, Capital Medical University from January 2019 to March 2023 were retrospectively analyzed. A total of 120 cases (120 sides, all first surgery) were included. According to whether complications occurred within 14 days after surgery, the patients were divided into a complication group and a non-complication group. The differences in clinical data between the two groups were analyzed, and the indicators with statistically significant differences were included in the multivariate logistic regression model to screen the related factors affecting postoperative complications. The 1 ∶2 propensity score matching method was used to screen the complication group and the non-complication group. We then compared the differences in modified Rankin Scale score (mRS) and CT perfusion-weighted imaging (CTP) staging between the two groups 3 to 6 months after surgery.

A total of 19 cases (15.83%) of 120 patients had postoperative complications, including 5 cases (4.17%) of cerebral infarction, 2 cases (1.67%) of cerebral hemorrhage, and 12 cases (10.00%) of transient neurological dysfunction. Compared with the non-complication group, patients in the complication group had a higher proportion of surgery on the left side, higher preoperative systolic blood pressure and hematocrit, higher white blood cell count and neutrophil-to-lymphocyte ratio (NLR) on the first postoperative day, higher systemic immune inflammation index, and the differences were statistically significant (all P<0.05). Multivariate logistic regression analysis showed that high preoperative systolic blood pressure (OR=1.06, 95%CI: 1.01-1.11, P=0.022) and high NLR on the first day after surgery (OR=1.14, 95%CI: 1.04-1.24, P=0.006), and the surgical side being the left side (OR=12.87, 95%CI: 2.68-61.70, P=0.001) were early warning factors for postoperative complications in patients. Comparing the complication group (15 cases) and the non-complication group (25 cases) using 1 ∶2 propensity score matching, there was no statistically significant difference in mRS or CTP staging 3 to 6 months after surgery (both P>0.05).

High preoperative systolic blood pressure, high NLR on the first postoperative day, and left-sided surgery are early warning factors for complications after intracranial-extracranial revascularization in patients with symptomatic atherosclerotic ICA or MCA occlusion. Newly-developed postoperative complications have no significant impact on the patient′s short-term outcomes.

To observe the efficacy of hybrid surgery in the treatment of spinal dural arteriovenous fistula (SDAVF), and to explore the related factors affecting patient prognosis.

The clinical data of 76 SDAVF patients admitted to the Neurosurgery Department of Tianjin Medical University General Hospital from January 2018 to January 2022 were retrospectively analyzed. All patients underwent hybrid surgery to cut off the SDAVF drainage vessels. MRI was used to observe the changes in spinal cord edema segments, edema cross-sectional area ratio, and major and minor diameters of edema; modified Aminoff and Logue score (mALS) was used to evaluate spinal cord neurological function, including mALS total score, lower limb motor function score and urination. and defecation function score; a decrease of ≥2 in the total mALS score 12 months after surgery compared to preoperative was considered improvement, a decrease of <2 was considered no significant improvement, and an increase of ≥2 was considered worsening. The differences in clinical data of patients with different outcomes were analyzed, and multivariate logistic regression analysis was used to analyze the related factors affecting patient outcomes.

The postoperative follow-up time [M(Q₁, Q₃)] of 76 patients was 15.0 (13.5, 20.0) months. MRI showed that spinal cord edema and tortuous vascular shadows improved in all patients after surgery, and no case recurred. Twelve months after surgery, among 76 patients, mALS improved in 33 patients (43.4%) and had no significant improvement in 43 patients (56.6%). Compared with the group without significant improvement, the patients in the improvement group had shorter disease duration, lower preoperative mALS total score and gait score, and fewer preoperative edema segments, and the differences were statistically significant (all P<0.05). However, there were no statistically significant differences in age, gender, fistula location, preoperative urinary and defecation function scores, or the ratio of major diameter, minor diameter, and cross-sectional area of spinal cord edema (all P>0.05). Multivariate logistic regression analysis showed that short disease duration (OR=0.92, 95%CI: 0.86-0.99, P=0.028) and low preoperative mALS total score (OR=0.76, 95%CI: 0.59-0.99, P=0.043) and a small number of spinal cord edema segments (OR=0.78, 95%CI: 0.62-0.98, P=0.035 ) were related to good outcome of the patient (all P<0.05).

After hybrid surgery for SDAVF, spinal cord neurological function recovers better after surgery. Short course of disease, low preoperative mALS and few spinal cord edema segments are important factors influencing the patient′s good prognosis.

To investigate the risk factors for poor outcome in patients with acute ischemic stroke (AIS) who obtained first-pass complete recanalization (FPCR), to construct a nomogram model with early prediction value.

Clinical data of patients with acute ischemic stroke with large vessel occlusion(AIS-LVO) who underwent mechanical thrombectomy and obtained FPCR from January 2020 to January 2023 in the Stroke Centre of the Affiliated Hospital of Nantong University (38 patients) and the Department of Interventional Radiology of the First Affiliated Hospital of Soochow University (60 patients) were retrospectively analyzed. According to 90-day modified Rankin scale(mRS) score, 98 patients were divided into favorable outcome group (mRS of 0-2) and unfavorable outcome group (mRS of 3-6). The general information, laboratory examination indexes, imaging examination indexes and operation information of patients in the two groups were compared. The items with statistically significant differences (P<0.05) were included in multivariate logistic regression analysis to identify the independent factors related to unfavorable outcome and construct a nomogram model. The performance of the nomogram was verified by the receiver operating characteristic (ROC) and calibration chart respectively.

There were 44 cases in favorable outcome group and 54 cases in unfavorable outcome group. The results of univariate analysis demonstrated that the observed differences between the two groups in terms of age, National Institute of Health stroke scale (NIHSS) score, Alberta stroke program early computed tomography score(ASPECTS), proportion of patients with clot burden score(CBS)>6, high regional leptomeningeal collateral(rLMC) grading, neutrophil count, neutrophil-to-lymphocyte ratio (NLR), platelet count, proportion of patients with local anesthesia, and proportion of hemorrhage transformation were statistically significant (all P<0.05). Multivariate logistic regression analysis showed that older age (OR: 0.94, 95%CI: 0.89-0.99, P=0.037), high NIHSS scores at admission (OR: 0.86, 95%CI: 0.77-0.97, P=0.010), high NLR (OR: 0.88, 95%CI: 0.77-0.99, P=0.045) and poor collateral status (OR: 0.03, 95%CI: 0.00-0.24, P=0.001) were independent risk factors for unfavorable outcome. Based on these results, a nomogram model was developed and the area under the ROC curve was 0.90 (95%CI: 0.84-0.96).

This nomogram, including age, NIHSS score on admission, NLR and collateral status may be used to predict individual probability of poor outcomes in AIS patients despite obtaining FPCR.

To explore the risk factors for contralateral hematoma progression (CHP) after unilateral drilling drainage of bilateral chronic subdural hematoma (bCSDH).

A retrospective study was conducted on 87 patients with bCSDH who underwent unilateral drilling and drainage at the Neurosurgery Center of Beijing Tiantan Hospital, Capital Medical University from November 2011 to April 2021. Three months after surgery, the patients were divided into CHP group and non-CHP group according to whether the contralateral hematoma progressed. The clinical data and imaging data of the two groups of patients were compared and analyzed, and the multivariate logistic regression was used to analyze the risk factors affecting CHP for variables with statistically significant differences.

Three months after surgery, 16 of 87 patients developed CHP, with an incidence rate of 18.4%. Among them, 9 cases occurred within 1 month after surgery, and 7 cases occurred 1 to 2 months after surgery. Five patients underwent conservative treatment for hematoma absorption, and 11 patients underwent surgical treatment to remove the hematoma. Among the patients with surgical treatment, 8 (72.7%) cases occurred within 1 month. There were 2 cases of hematoma recurrence on the operated side within 6 months after surgery, both of which were non-CHP patients. Compared with 71 patients in the non-CHP group, the maximum thickness of the contralateral hematoma before extubation was significantly increased in 16 patients in the CHP group (P<0.001); the contralateral hematoma was located on the curved side (P=0.018) and was extensive (P=0.001), and the CT classification was mixed type (P=0.034) with a high proportion. Multivariate logistic regression analysis of only preoperative related factors showed that extensive hematoma (OR=5.34, 95%CI: 1.29-22.06, P=0.021) was a risk factor for CHP; after including postoperative variables for analysis, extensive hematoma (OR=4.60, 95%CI: 1.02-20.72, P=0.047) and maximum thickness of contralateral hematoma before extubation (OR=21.99, 95%CI: 1.85-260.81, P=0.014) were the risk factors of CHP.

The period of high incidence of CHP in patients with bCSDH is within 2 months after unilateral cranial burr hole drainage. Extensive hematoma is an independent risk factor for CHP before surgery; the maximum thickness before extubation is also an independent risk factor for CHP after surgery.

To explore the anatomical landmarks of the V3 segment of the vertebral artery and the preservation strategies in the suboccipital approach.

Ten adult cadaveric head specimens (20 sides) were fixed with 10% formaldehyde. The occipital muscles were dissected layer by layer from superficial to deep, the suboccipital triangle was located, and the venous plexus around the vertebral artery was removed to expose and observe the V3 segment of the vertebral artery. Then, the structures adjacent to the V3 segment of the vertebral artery were observed from the axial direction via the posterior suboccipital midline approach, the suboccipital retrosigmoid approach, and the extreme-lateral transjugular process approach. The distance between key bony landmarks of each approach and the vertebral artery was measured, respectively.

The V3 segment of the vertebral artery was wrapped by the muscles of the suboccipital triangle and the venous plexus around the vertebral artery. The length of the V3 segment was 19.7±2.7 mm, with an outer diameter of 5.4±1.3 mm. The distance from the posterior tubercle of the atlas to the medial edge of the V3 segment was 19.1±4.1 mm in the posterior suboccipital midline approach. The vertical distance from the horizontal part of the occipital scale to the upper edge of the V3 segment was 8.7±2.6 mm, which was similar to that from the condylar fossa to the upper edge of the V3 segment(8.7±2.5 mm) in the suboccipital retrosigmoid approach. The straight-line distance from the posterior edge of the jugular foramen to the lateral edge of the V3 segment was 10.4±1.7 mm in the extreme-lateral transjugular process approach.

Familiarity with the microanatomy of the vertebral artery V3 segment and its distances from surrounding landmarks can provide reference for identifying the vertebral artery V3 segment during surgery, reducing the risk of injury to the vertebral artery, and improving the safety of surgery in the occipital region.

To analyze the bacteria composition in primary tumor tissues of patients with glioblastomas (GBM) and to study the function and mechanism of intratumoral bacteria-related characteristic genes in GBM.

A total of 152 cases of primary GBM were analyzed based on the public data of bacteria-related genes within tumors based on The Cancer Genome Atlas (TCGA). According to the median overall survival time of GBM patients, they were divided into a low survival group (78 cases) and a high survival group (74 cases). Differences in α diversity between groups were evaluated using rank sum tests. Non-metric multidimensional scaling (NMDS) analysis and principal co-ordinates analysis (PCoA) were used to assess the differences in β diversity between groups. Linear discriminant analysis (LDA) was used to compare bacteria-related characteristic genes in two groups of GBM samples. According to the relative abundance of different bacteria-related characteristic genes, 152 patients were divided into high abundance group and low abundance group. Kaplan-Meier method was used to analyze the difference in survival rate between the high abundance group and the low abundance group. Gene ontology (GO) functional annotation of biological processes and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were performed for significantly upregulated genes in high-abundance bacterial-related characteristic gene samples associated with better prognosis. Tumor immune microenvironment landscape was analyzed by TCGA transcriptome sequencing data set, and the correlation between immune cell infiltration content and prognostic related bacterial characteristic genes was analyzed by Mantel test. All data were analyzed using R software, and P<0.05 was considered statistically significant.

A total of 252 bacteria-related characteristic genes were identified in 152 GBM tissues, of which 234 were present in both the low survival group and the high survival group, 8 were present only in the low survival group and 10 were present only in the high survival group. NMDS and PCoA analyses showed significant statistical differences in β diversity between the two groups. LDA analysis showed that bacteria-related characteristic genes in tumor tissues was different between the high survival group and the low survival group (P<0.05). The abundance of Bacteroides fragile-related characteristic genes was higher in the high survival group (P<0.05), and was positively correlated with the overall survival of patients (χ²=4.13, P<0.05). Functional enrichment analysis showed that genes related to immune pathway were highly expressed in tumor tissues of patients with higher abundance of Bacteroides fragilis-related characteristic genes (P<0.05). Mantel test analysis results showed that the abundance of Bacteroides fragilis-related characteristic genes in primary GBM tumor tissues was positively correlated with M1 macrophage infiltration (P<0.05).

Bacteroides_fragilis-related characteristic genes are more abundant in primary tumors from high survival GBM patients and impact the tumor immune microenvironment.

To investigate the role of ubiquitin conjugating enzyme E2L3 (UBE2L3) in M1 microglia-associated neuroinflammation following traumatic brain injury, along with its underlying mechanisms.

Sprague-Dawley rats were used to construct rat models of traumatic brain injury (TBI) and Sham operation; peptide histology was used to screen the differentially expressed peptides in cortical brain tissues around the traumatic lesions of the Sham group and the TBI group at 3 d. The UBE2L3 protein, which was down-regulated more significantly, was selected as a target. The expression of UBE2L3 in the brain tissues of TBI rats and different BV2 cell models was verified by protein western blotting (WB) and real-time fluorescence quantitative PCR (qPCR) respectively. UBE2L3 plasmid was transfected into BV2 cells and the cells were divided into negative control group (NC) and UBE2L3 overexpression group (OE-UBE2L3). The overexpression of the UBE2L3 gene was identified by qPCR and WB experiments. A lipopolysaccharide (LPS)-induced M1-type microglial neuroinflammation model was constructed, and the experiment was divided into NC group, OE-UBE2L3 group, LPS group and LPS-UBE2L3 group. The effects of UBE2L3 overexpression on microglia polarization and inflammatory factor expression were detected by immunofluorescence staining and qPCR experiments, respectively. The effects of UBE2L3 overexpression on the phosphorylation levels of cyclooxygenase 2 (COX2) protein and nuclear factor κB (NF-κB) p65 protein in the NF-κB pathway were analyzed by WB assay.

The results of peptidomics mass spectrometry analysis showed that the expression levels of peptides contained in UBE2L3 proteins in the brain tissues around the lesions of TBI rats were significantly lower than that of Sham group, with statistical significance (P=0.046). WB verification experiment showed that the expression level of UBE2L3 in BV2 cell neuroinflammation model was down-regulated at 12 h compared with 0 h, with statistical significance (P<0.01). In the brain tissue of TBI rats, compared with Sham group, UBE2L3 expression level was down-regulated at day 1 after TBI (0.804±0.056 vs. 1.394±0.263), and tended to be flat at day 7 (0.558±0.024), with statistical significance (all P<0.01). WB identification experiment showed that UBE2L3 overexpressed cell model was successfully constructed, and UBE2L3 expression level in OE-UBE2L3 group was higher than that in NC group (0.908±0.052 vs. 0.362±0.080), the difference was statistically significant (P<0.01). The experiment of qPCR showed that the expression levels of interleukin (IL)-1β, IL-6 and tumor necrosis factor α (TNF-α) in LPS group were higher than those in NC group, while the expression levels of IL-1β, IL-6 and TNF-α in LPS-UBE2L3 group were lower than those in LPS group, with statistical significance (all P<0.01). The immunofluorescence experiment showed that the expression level of M1 standard substance iNOS in microglia in LPS group was higher than that in NC group, and the difference was statistically significant (P<0.001). The WB test of the pathway protein showed that the expression level of COX2 protein in LPS-UBE2L3 group was lower than that in LPS group (0.460±0.280 vs. 1.273±0.090), and the difference was statistically significant (P<0.05). Phosphorylated NF-κB p65 expression level in LPS group was up-regulated compared with NC group (1.738±0.138 vs. 0.614±0.192), and down-regulated compared with LPS group (0.924±0.207). The differences were statistically significant (both P<0.05).

UBE2L3 can exert an anti-inflammatory function by inhibiting the polarization of microglia to the M1 phenotype after TBI through the modulation of the NF-κB/COX2 pathway, and it may serve as a potential therapeutic target for suppressing neuroinflammation after TBI.

In April 2021, a patient with middle cerebral artery dissection aneurysm with angulation and "jet sign" blood flow was admitted to the Cerebrovascular Intervention Center of Henan Provincial People's Hospital. After blood flow guidance device (FD) was used to assist coil embolization during the operation, a balloon dilatation stent with stronger support was inserted into the FD, and the shape of the blood vessel was changed by straightening to correct the jet blood flow and promote FD adhesion, thus improving the healing rate of the aneurysm and reducing the recurrence rate. This patient achieved technical success with a clinical follow-up of 25 months after surgery, showing a good prognosis.

Desmoid fibromatosis originates from fibroblasts and has the characteristics of local invasive growth, no distant metastasis and easy recurrence. The disease mostly occurs in the chest, abdomen and limbs, while the occurrence of head and neck lesions after surgery is rarely reported. The clinical characteristics of organized chronic subdural hematoma are similar to desmoid fibroma, which are easily confused and difficult to differentiate clinically. In June 2014, the Department of Neurosurgery of the First Affiliated Hospital of Jiamusi University admitted a patient who was initially diagnosed with organized chronic subdural hematoma after cranioplasty. Subsequently, combined with pathological examination and intraoperative findings, he was finally diagnosed with desmoid fibromatosis. No recurrence was seen after 5 years of follow-up.

In recent years, gene editing technology has made breakthrough and revolutionary progress, and humans have been able to directly change the genetic structure information of organisms. This technology opens up a new way for in-depth study of disease mechanisms and exploration of gene therapy options. Among many gene editing tools, base editing technology has become a research hotspot in recent years because of its accuracy, efficiency and safety. However, there is still a lack of systematic reports on the research and application of this technique in the field of neurosurgery. In order to fill this gap, this paper aims to introduce the principle and development of base editing technology, and summarize its application progress in the field of neurosurgery, in order to provide help for the research and treatment of neurosurgical diseases based on base editing technology.

Spontaneous cerebellar hemorrhage accounts for about 9% to 10% of all spontaneous intracranial hemorrhage, which is manifested as hemorrhage of cerebellar parenchyma, among which essential hypertension is the most common cause. At present, there are related studies that divide spontaneous cerebellar hemorrhage into benign cerebellar hemorrhage and malignant cerebellar hemorrhage, and stipulate new surgical indications. The main purpose of surgical treatment is to remove hematoma, reduce intracranial pressure and reduce the compression of peripheral nerves caused by hematoma. This article mainly reviews the surgical treatment methods of spontaneous cerebellar hemorrhage (including suboccipital decompressive craniectomy, neuroendoscopic hematoma evacuation, stereotactic minimally invasive hematoma evacuation and external ventricular drainage combined with intraventricular fibrinolysis), in order to provide reference for the clinical diagnosis and treatment of this disease.